scholarly journals High Prevalence of Acquired Thrombophilia Without Prognosis Value in Patients With Coronavirus Disease 2019

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Emile Ferrari ◽  
Benjamin Sartre ◽  
Fabien Squara ◽  
Julie Contenti ◽  
Celine Occelli ◽  
...  
Keyword(s):  
Antiphospholipid Antibodies ◽  
Viral Infections ◽  
Pathological Condition ◽  
Protein S ◽  
Severe Form ◽  
Unique Identifier ◽  
High Prevalence ◽  
Severity Of The Disease ◽  
Thrombotic Tendency ◽  
Acquired Thrombophilia

Background Recent literature reports a strong thrombotic tendency in patients hospitalized for a coronavirus disease 2019 (COVID‐19) infection. This characteristic is unusual and seems specific to COVID‐19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia, which can then lead to thrombotic complications. We investigate for the presence of acquired thrombophilia, which could participate in this phenomenon, and report its prevalence. We also wonder if these thrombophilias participate in the bad prognosis of severe COVID‐19 infections. Methods and Results In 89 consecutive patients hospitalized for COVID‐19 infection, we found a 20% prevalence of PS (protein S) deficiency and a high (ie, 72%) prevalence of antiphospholipid antibodies: mainly lupus anticoagulant. The presence of PS deficiency or antiphospholipid antibodies was not linked with a prolonged activated partial thromboplastin time nor with D‐dimer, fibrinogen, or CRP (C‐reactive protein) concentrations. These coagulation abnormalities are also not linked with thrombotic clinical events occurring during hospitalization nor with mortality. Conclusions We assess a high prevalence of positive tests detecting thrombophilia in COVID‐19 infections. However, in our series, these acquired thrombophilias are not correlated with the severity of the disease nor with the occurrence of thrombotic events. Albeit the strong thrombotic tendency in COVID‐19 infections, the presence of frequent acquired thrombophilia may be part of the inflammation storm of COVID‐19 and should not systematically modify our strategy on prophylactic anticoagulant treatment, which is already revised upwards in this pathological condition. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT04335162.

Early Pathophysiology of Osteonecrosis

1998 ◽  
Vol 8 (2) ◽  
pp. 71-79
Author(s):  
J.P. Jones
Keyword(s):  
Antiphospholipid Antibodies ◽  
Protein C ◽  
Viral Infections ◽  
Proteolytic Enzymes ◽  
Arterial Occlusion ◽  
Plasminogen Activator Inhibitor ◽  
Protein S ◽  
Disc Disease ◽  
Organ Rejection ◽  
Intravascular Coagulation

Current concepts regarding the early pathophysiology of osteonecrosis (ON) are reviewed. Traumatic ON appears to result from arterial severance, an acute ischaemic event. Intravascular coagulation of the intraosseous microcirculation (capillaries and venous sinusoids) progressing to generalized venous thrombosis, and less commonly retrograde arterial occlusion, now appears to be the genesis of nontraumatic ON. However, a coagulopathy is only an intermediary event, which is always activated by some underlying aetiological risk factor(s). Conditions capable of triggering intravascular coagulation include familial thrombophilia (resistance to activated protein C, decreased protein C, protein S, or antithrombin III), hyperlipaemia and embolic lipid (alcoholism and hypercortisonism), hypersensitivy reactions (allograft organ rejection, immune complexes, and antiphospholipid antibodies), bacterial endotoxic (Shwartzman) reactions and various viral infections, proteolytic enzymes (pancreatitis), tissue factor release (inflammatory bowel disease, malignancies, neurotrauma, and pregnancy), and other prethrombotic and hypofibrinolytic conditions. In order to exceed the ischaemic threshold and produce ON, significant residual fibrin-platelet microthrombi must remain within the intraosseous vasculature for a minimum of two to six hours, and not be immediately removed by endogenous fibrinolysis. Hypofibrinolysis with increased plasminogen activator inhibitor has been found in patients with ON. The thrombotic threshold may be decreased in those hypercoagulable patients with hereditary thrombophilia, antiphospholipid antibodies, or hyperlipaemia. Subsequent exposure to an additional factor should facilitate intraosseous thrombosis and ON. It is also conceivable that fractional subchondral ON can cause both degenerative disc disease and “primary” osteoarthritis of aging and obesity.

Superficial vein thrombosis in non-varicose veins of the lower limbs and thrombophilia

2017 ◽  
Vol 33 (4) ◽  
pp. 278-281 ◽  
Author(s):  
Gabriella Lucchi ◽  
Salvino Bilancini ◽  
Sandro Tucci ◽  
Massimo Lucchi
Keyword(s):  
Varicose Veins ◽  
Factor V Leiden ◽  
Protein S ◽  
Lower Limbs ◽  
Factor V ◽  
Superficial Vein ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis ◽  
High Prevalence ◽  
Acquired Thrombophilia

Objectives Superficial vein thrombosis in non-varicose veins of the lower limbs is rather frequent and may be underestimated. This study aims to evaluate the prevalence of inherited or acquired thrombophilia in a sample of outpatients with the disease. Method An observational study was conducted on 73 consecutive superficial vein thrombosis patients tested for inherited or acquired thrombophilia. Results Sixty of 73 patients with superficial vein thrombosis completed the testing protocol, while 13 dropped out; 46 of 60 patients were found to have a thrombophilia (76.6%). The types detected were: factor V Leiden (31/60, i.e. 51.6%), prothrombin mutation (2/60, i.e. 3.3%), MTHFR mutation (23/60, i.e. 38.3%), antiphospholipid antibodies (5/60, i.e. 8.3%), protein C deficit (1/60, i.e. 1.6%), protein S deficit (1/60, i.e. 1.6%), and antithrombin deficit (0/60, i.e. 0%). Conclusions Among patients with superficial vein thrombosis in non-varicose veins, testing demonstrated a high prevalence of thrombophilia. The most common form proved to be factor V Leiden. As thrombophilia was found to be a major cause of superficial vein thrombosis in non-varicose veins, the authors recommend that patients with superficial vein thrombosis in non-varicose veins be investigated for thrombophilia.

Factor V Leiden: An Additional Risk Factor for Thrombosis in Protein S Deficient Families?

1995 ◽  
Vol 74 (02) ◽  
pp. 580-583 ◽  
Author(s):  
B P C Koeleman ◽  
D van Rumpt ◽  
K Hamulyák ◽  
P H Reitsma ◽  
R M Bertina
Keyword(s):  
Protein C ◽  
Normal Population ◽  
Factor V Leiden ◽  
Protein S ◽  
Reliable Estimate ◽  
Additional Risk Factor ◽  
Protein S Deficiency ◽  
S Deficiency ◽  
High Prevalence ◽  
Fv Leiden

SummaryWe recently reported a high prevalence of the FV Leiden mutation (R506Q, responsible for Activated Protein C resistance) among symptomatic protein C deficient probands (19%), and the involvement of the FV Leiden mutation in the expression of thrombophilia in six protein C deficient families. Here, we report the results of a similar study in protein S deficient probands and families. Among 16 symptomatic protein S deficient probands the prevalence of the FV Leiden mutation was high (38%). This high prevalence is significantly different from that in the normal population, and is probably caused by the selection of probands for familial thrombosis and protein S deficiency. In 4 families, the segregation of the FV Leiden mutation and the protein S deficiency could be studied. In sibships where both abnormalities were segregating, the percentage of symptomatic individuals with both abnormalities was 80%. Three of the seven subjects with only the FV Leiden mutation, and two out of the three subjects with only protein S deficiency had developed thrombosis. These results indicate that in the families presented here the combination of the FV Leiden mutation and the protein S deficiency is associated with a high risk for thrombosis. A reliable estimate of the penetrance of the single defects is not possible, because the number of individuals with a single defect is too low.

scholarly journals Psychological processes in the experience of hereditary angioedema in adult patients: an observational study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Livia Savarese ◽  
Maria Bova ◽  
Assunta Maiello ◽  
Angelica Petraroli ◽  
Ilaria Mormile ◽  
...  
Keyword(s):  
Hereditary Angioedema ◽  
Severity Score ◽  
Psychological Intervention ◽  
Pathological Condition ◽  
High Stress ◽  
Adult Patients ◽  
Social Impairment ◽  
C1 Inhibitor Deficiency ◽  
Patient Health ◽  
Severity Of The Disease

Abstract Background Hereditary angioedema associated to C1 inhibitor deficiency (C1-INH-HAE) is a pathological condition characterized by episodes of subcutaneous swelling and it is frequently associated with discomfort and social impairment of the patients, due to the anxiety experienced for an unpreventable manifestation of an attack during daily life. In children increased level of stress and alexithymia have been associated to C1-INH-HAE, and the latter correlated also with the severity of the disease. We hypothesized that the involvement of psychological issues may impact on the severity of C1-INH-HAE in adult patients as well, interfering with their ability to engage with the management of the disease. Methods 28 adult patients with C1-INH-HAE were evaluated for clinical (C1-INH-HAE Severity Score) and psychological factors (alexithymia, emotion regulation, stress, patient health engagement, general severity index) by means of validated questionnaires. Results Mean age (standard deviation [SD]) was 45 (11) years and time from diagnosis was 20 (12) years. The mean C1-INH-HAE severity score was 6.4. Alexithymia was absent in 22 (78%) patients. Moderate and high stress levels were present in 17 (61%) and 4 (14%) patients, respectively. Moderate-high discomfort was experienced by 9 (36%) patients and a discomfort beyond the clinical attention threshold was shown by 3 (12%) patients. Stress correlated with patient health engagement and with psychological discomfort. Conclusions In C1-INH-HAE, patients health engagement and moderate-high psychological discomfort are linked with stress but not with the severity of the disease or alexithymia. A better patient health engagement may be a target for psychological intervention in clinics to ameliorate the stress perceived by C1-INH-HAE patients.

Indicators of the kinin blood system in severe forms of acute respiratory viral infections in children

1982 ◽  
Vol 63 (2) ◽  
pp. 51-52
Author(s):  
V. A. Anokhin ◽  
A. D. Tsaregorodtsev
Keyword(s):  
Viral Infection ◽  
Viral Infections ◽  
Severe Form ◽  
Blood System ◽  
Control Group ◽  
Healthy Children ◽  
Respiratory Viral Infection ◽  
Respiratory Viral Infections ◽  
Acute Respiratory Viral Infection ◽  
Apparently Healthy

The aim of this work was to study the parameters of the components of the kinin blood system in children with severe forms of acute respiratory viral infections (ARVI) with neurotoxicosis syndrome. 55 children with ARVI (aged from 1 to 6 months - 14, from 6 months to 1 year - 18, from 1 to 3 years - 11, from 3 to 7 years - 12). 38 patients were admitted in the first three days of illness, 12 - on 4-5 days and 5 - at a later date. 30 children had a severe form of acute respiratory viral infection and 25 - moderate. Adenovirus infection was diagnosed in 14 patients, influenza - in 16, parainfluenza - in 7, MS-viral infection in 5, mixed viral infection - in 13. The control group consisted of 10 apparently healthy children.

15 Triggers for the pharmacological management of delirium in palliative care: a mixed methods study

2018 ◽  
Vol 8 (3) ◽  
pp. 365.2-365
Author(s):  
Catherine L Fairfield ◽  
Anne M Finucane ◽  
Juliet A Spiller
Keyword(s):  
Palliative Care ◽  
Severe Form ◽  
Screening Tools ◽  
Pharmacological Intervention ◽  
Inpatient Setting ◽  
List Type ◽  
Structured Interviews ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
High Prevalence

IntroductionDelirium is a serious neurocognitive disorder with a high prevalence in palliative care and debate regarding its management is ongoing.AimsTo describe how delirium and its symptoms is documented in patient recordsTo determine the use of delirium screening tools and how these are viewed by staffTo identify triggers for pharmacological intervention in delirium management in a terminally ill population.MethodsA retrospective case-note review concerning all patients admitted to a hospice inpatient setting between 1–17th August 2017 and semi-structured interviews with 7 hospice doctors and nurses.Results21 patients were reviewed. 62% were screened for delirium using the 4AT on admission. 76% had documented symptoms of delirium and of these 81% died without delirium resolution. There were inconsistencies in the documentation of delirium and the term itself was used infrequently. Non-pharmacological measures were poorly documented. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures distress agitation and risk of patient harm. Nursing staff recognised delirium in its severe form but were less likely to do so in milder cases.ConclusionsTriggers for pharmacological intervention are in-keeping with guidelines however the level of understanding of delirium’s presentation varied between participants. This along with the high prevalence of delirium frequent use of midazolam and limited awareness and documentation of non-pharmacological measures (e.g. structured family support) highlights the need for further training and research.

scholarly journals Antiphospholipid Antibodies and Acquired Thrombophilia: A Biological Marker for Recurrent Miscarriage

2021 ◽  
pp. 137-143
Author(s):  
Rania Khogli ELsidig Khogli ◽  
Abdel Rahim Mahmoud Muddathir ◽  
Alaa Eltayeb Omer ◽  
Lienda Bashier Eltayeb
Keyword(s):  
Partial Thromboplastin Time ◽  
Antiphospholipid Antibodies ◽  
Tissue Injury ◽  
Recurrent Miscarriage ◽  
Biological Marker ◽  
Activated Partial Thromboplastin Time ◽  
P Value ◽  
Increased Risk ◽  
The One ◽  
Acquired Thrombophilia

Background: Repeated miscarriage can cause tissue injury can lead to the formation of antibodies to the phospholipids. Recurrent miscarriage (RM) is considering the one of the most common cause of sterility. Which has received more attention in recent years as a result of an increase in the number of reproductive-aged women. Materials and Methods: Plasma samples were tested for antiphospholipid antibodies using ELISA, and platelet count using Sysmex (KX21) Heamatology analyzer and Activated Partial Thromboplastin Time using semi-automated machine (STAGO PT31039352 (for coagulation). Results: The prevalence of Anti phospholipid antibodies (APL) was 30.5% in Sudanese patients with recurrent miscarriage, the prevalence of (Anti phospholipid Antibodies-IgM and IgG) was found to be 23.6% in patients with recurrent miscarriage compared to (Anti phospholipid Antibodies-IgG) was found to be 11.1% ((P value≤0.001), low platelets count (<50×109/l) observed in 10 (13.5%), as well as prolongation of activated partial thromboplastin time (APTT) among studied group were detected among 19 (26.1%). Conclusion: Higher prevalence of antiphospolidids antibodies, and acquired thrombophilia was detected among Sudanese women with recurrent abortion; The findings are concerning because they link an increased risk of thrombosis and a hypercoagulable state lead to recurrent miscarriage in pregnant women.

“OUTCOME ANALYSIS OF TIMELY CONSERVATIVE MANAGEMENT OF HAEMOPHILIC KNEE ARTHROPATHY WITH FACTOR REPLACEMENT AND PHYSIOTHERAPY.”

2021 ◽  
pp. 58-61
Author(s):  
Vivek Kumar ◽  
Kashif Iqbal ◽  
Abhishek Chaturvedi ◽  
Abhinendra Singh
Keyword(s):  
Rural Population ◽  
Coagulation Factors ◽  
Severe Form ◽  
Factor Ix ◽  
Joint Disease ◽  
Outcome Analysis ◽  
Common Complication ◽  
Positive Role ◽  
Chronic Synovitis ◽  
Severity Of The Disease

INTRODUCTION: Haemophilia is a disorder of the initiation of coagulation, and is due to reductions in the concentrations of, or the presence of a less active version of, one of two coagulation factors, factor VIII and factor IX. There are several orthopaedic problems linked to haemophilia including recurrent hemarthroses, chronic synovitis, exion deformities, hypertrophy of the growth epiphyses, damage to the articular cartilage and hemophilic arthropathy MATERIALS AND METHODS : 290 patients of all age group of haemophilia A and B coming to orthopaedic OPD with Knee Haemarthosis between October 2018 to May 2020 were included in our study. These patients were prospectively analyzed for complications and severity. HJHS Scoring system were used to assess the severity of joint disease. RESULTS : . out of 290 patients it was found that haemophilia was more prevalent in rural population (53.10%) as compared to urban population (46.90%). In our study it was found that majority of the patients with haemophilia had single joint involved (57.94%) as compared to 42.06% who had multiple joint involved. It was revealed that in majority right knee was involved (52.41%) followed by left joint in 47.58% patients with haemophilia. It was found that most common complication in patients of knee haemarthrosis was recurrent haemarthrosis (57.24%) followed by synovitis (27.93%). arthropathy (9.31%) . It was found that most common complication in patients of knee haemarthrosis was recurrent haemarthrosis (57.24%) followed by synovitis (27.93%). arthropathy (9.31%) . It was found that out of 290 patients with haemophilia, majority were performing regular physiotherapy (57.59%) followed by 42.41% of the patients who were occasional in physiotherapy. It was found that mean HJHS score was increasing with increasing the severity of the disease. Mean HJHS score for mild cases was 10.53±4.495 as compared to 13.06±7.575 of moderate cases and 17.82±7.991 of severe cases. CONCLUSION In present study haemophilia was more prevalent in rural population. Majority of the patients with haemophilia had single joint and in majority right knee was involved. Most common complication in patients of haemophilia was recurrent haemarthrosis followed by synovitis and arthropathy. Majority of our patients were having severe form of the disease. Adequate factor replacement along with good active physiotherapy early detection and prompt treatment with active life style makes muscles and joints healthier and stronger reduces tendancy of bleeding and further damage of joint. reduce the frequency and longterm complications of knee haemarthrosis like recurrent haemarthosis , synovitis ,arthropathy, fracture and deformity. Prophylactic factor replacement is having denitely positive role as per available literature over western countries, unfortunately it needs more specic clinical trial to know about longterm good results in India.

scholarly journals Feline Foamy Virus is Highly Prevalent in Free-Ranging Puma concolor from Colorado, Florida and Southern California

Viruses ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 359 ◽  
Author(s):  
Sarah R. Kechejian ◽  
Nick Dannemiller ◽  
Simona Kraberger ◽  
Carmen Ledesma-Feliciano ◽  
Jennifer Malmberg ◽  
...  
Keyword(s):  
Southern California ◽  
Viral Infections ◽  
Puma Concolor ◽  
Foamy Virus ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Domestic Cat ◽  
Wild Populations ◽  
High Prevalence ◽  
Free Ranging

Feline foamy virus (FFV) is a retrovirus that has been detected in multiple feline species, including domestic cats (Felis catus) and pumas (Puma concolor). FFV results in persistent infection but is generally thought to be apathogenic. Sero-prevalence in domestic cat populations has been documented in several countries, but the extent of viral infections in nondomestic felids has not been reported. In this study, we screened sera from 348 individual pumas from Colorado, Southern California and Florida for FFV exposure by assessing sero-reactivity using an FFV anti-Gag ELISA. We documented a sero-prevalence of 78.6% across all sampled subpopulations, representing 69.1% in Southern California, 77.3% in Colorado, and 83.5% in Florida. Age was a significant risk factor for FFV infection when analyzing the combined populations. This high prevalence in geographically distinct populations reveals widespread exposure of puma to FFV and suggests efficient shedding and transmission in wild populations.

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